Bone Mineral Density of Young Korean Women and Its Correlation with Thyroid Stimulating Hormone / 대한골다공증학회지

OBJECTIVES: The bone mineral density (BMD) of young aged women was not fully investigated because of the limited indication of BMD test. This study was to investigate mean Z-score of BMD in healthy young aged Korean women and to find out factors influencing the BMD score in her twenties and thirties. METHODS: A total 876 young aged (20-40 years) women who had taken dual energy X-ray absorptiometry (DXA) for BMD screening from 2010 to 2014 were analyzed retrospectively using demographic data including body mass index (BMI), waist circumference (WC), thyroid stimulating hormone (TSH), and serum lipid profile. We compared the two age groups, in her twenties and thirties, regarding BMD and other parameters.

Spectrum of Various Male Breast Lesions: Pictorial Review with Radiologic-Pathologic Correlation

Most men referred for breast imaging have palpable lumps. Most lesions that are evaluated are benign, and malignancy is less common. Although there are characteristic imaging features of malignancy, substantial overlap is presented between benign and malignancy. Therefore, other imaging modalities are increasingly being used for accurate evaluation. We report on various male breast lesions using ultrasonography, mammography, computed tomography, and positron emission tomography-computed tomography. Pathognomonic histologic findings of each case are also provided.

Efficacy of Fluoroscopy-Guided Cutting Needle Lung Biopsy in Patients with Diffuse Infiltrative Lung Disease / 결핵및호흡기질환

BACKGROUND: Open lung biopsy is used for diagnosis of diffuse infiltrative lung diseases (DILD), but it is invasive and relatively expensive procedure. Fluoroscopy-guided cutting needle lung biopsy (FCNLB) has merits of avoidance of admission and rapid diagnosis. But diagnostic accuracy and safety were not well known in the diagnosis of DILD. METHODS: We included 52 patients (37 men, 15 women) having DILD on HRCT with dyspnea, except the patients who could be confidently diagnosed with clinical and HRCT findings. FCNLB was performed using 16G Ace cut needle (length 1.5 cm, diameter 2 mm) at the area of most active lesion on HRCT. Final diagnoses were made by the consensus. RESULTS: The mean interval between the HRCT and FCNLB was 4.5 days. Most cases were performed one biopsy during 5~10 minutes. Specific diagnosis was obtained in 43 of 52 biopsies (83%). The most common diagnosis was nonspecific interstitial pneumonia (11 cases) and followed by cryptogenic organizing pneumonia (7 cases), diffuse alveolar hemorrhage and usual interstitial pneumonia (5 cases in each), hypersensitivity pneumonitis (3 cases), tuberculosis and drug induced interstitial pneumonitis (2 cases in each), the others are in one respectively. Mild complication was developed in 9 patients (8 pneumothorax, 1 hemoptysis). Most of complications were regressed without treatment except one case with chest tube insertion for pneumothorax. CONCLUSION: Fluoroscopy-guided 16 G cutting needle lung biopsy was an useful method for the diagnosis of DILD.

Efficacy of Fluoroscopy-Guided Cutting Needle Lung Biopsy in Patients with Diffuse Infiltrative Lung Disease / 결핵및호흡기질환

BACKGROUND: Open lung biopsy is used for diagnosis of diffuse infiltrative lung diseases (DILD), but it is invasive and relatively expensive procedure. Fluoroscopy-guided cutting needle lung biopsy (FCNLB) has merits of avoidance of admission and rapid diagnosis. But diagnostic accuracy and safety were not well known in the diagnosis of DILD. METHODS: We included 52 patients (37 men, 15 women) having DILD on HRCT with dyspnea, except the patients who could be confidently diagnosed with clinical and HRCT findings. FCNLB was performed using 16G Ace cut needle (length 1.5 cm, diameter 2 mm) at the area of most active lesion on HRCT. Final diagnoses were made by the consensus. RESULTS: The mean interval between the HRCT and FCNLB was 4.5 days. Most cases were performed one biopsy during 5~10 minutes. Specific diagnosis was obtained in 43 of 52 biopsies (83%). The most common diagnosis was nonspecific interstitial pneumonia (11 cases) and followed by cryptogenic organizing pneumonia (7 cases), diffuse alveolar hemorrhage and usual interstitial pneumonia (5 cases in each), hypersensitivity pneumonitis (3 cases), tuberculosis and drug induced interstitial pneumonitis (2 cases in each), the others are in one respectively. Mild complication was developed in 9 patients (8 pneumothorax, 1 hemoptysis). Most of complications were regressed without treatment except one case with chest tube insertion for pneumothorax. CONCLUSION: Fluoroscopy-guided 16 G cutting needle lung biopsy was an useful method for the diagnosis of DILD.

Malignant Pleural Mesothelioma with Heterologous Osteoblastic Differentiation: Case Report of the Characteristic CT and Bone Scan Findings

Malignant pleural mesothelioma is an uncommon neoplasm which is accompanied extremely rarely by osteoblastic heterologous elements. The CT manifestations of this tumor have been reported in several references. And, to our knowledge, only one case report provides a description of the bone scan findings. Here, we report the case of a rapidly progressing malignant pleural mesothelioma with heterologous osteoblastic elements. A CT scan reveals diffuse irregular pleural thickening and very coarse nodular calcifications along the right pleura and major fissure. A bone scan revealed an area of extensive increased radioactivity consistent with the pleural calcifications on the CT scan in the right hemithorax. A follow-up CT scan performed 40 days later suggests the presence of rapidly progressing nodular coarse calcifications.

A case of Swyer-James Syndrome Successfully Treated with Methylprednisolone Pulse Therapy / 소아알레르기및호흡기학회지

Swyer-James syndrome (SJS) is characterized by a small- or normal-sized unilateral hyperlucent lung with decreased vascularity and air trapping on plain radiographs. SJS is considered to be a postinfectious form of bronchiolitis obliterans and has occurred following childhood pulmonary infection by adenovirus, measles, influenza virus, Bordetella pertussis, Mycobacterium tuberculosis or Mycoplasma pneumoniae. The standard treatment modality for SJS is supportive care. Despite the prominent role of inflammation in the pathogenesis of SJS, the use of corticosteroids has remained controversial. We report herein a case of SJS which was successfully treated with monthly methylprednisolone pulse therapy, resulting in complete remission as verified by high resolution computed tomography.

Percutaneous Transthoracic Needle Biopsy of Pulmonary Lesions: a National Survey of Korean Practice

PURPOSE: This study surveyed the thoracic radiologists in Korea in order to determine how they performed percutaneous transthoracic needle biopsy of pulmonary lesions. MATERIALS AND METHODS: In February 2006, fifty questionnaires were mailed to the members of the Society of Thoracic Radiology in the Republic of Korea (KSTR), and these doctors worked in academic and community hospitals. The survey consisted of multiple-choice questions regarding the radiologist's approach to a transthoracic needle biopsy (the type of practice, the imaging guidance technique, the biopsy technique, monitoring during the procedure, the assessment of pneumothorax after the procedure and the diagnostic accuracy) on the basis of the guidelines of the British Thoracic Society (BTS) and the European Respiratory Society (ERS)/American Thoracic Society (ATS). RESULTS: A total of 39 (66.1%) KSTR members responded. For the biopsy guidance, 16(41.0%) responder performed the procedure under CT guidance, 19(48.7%) responders performed the procedure under fluoroscopy guidance only and 4(10.3%) responders performed the procedure under either CT or fluoroscopy guidance. Fine-needle aspiration was the procedure of choice for eight (20.5%) respondents, whereas 31(79.5%) preferred performing a cutting needle biopsy. Before doing the procedure, 38(97.4%) institutions performed coagulation tests. All the respondents routinely performed follow-up imaging to determine the presence of a pneumothorax. PTNB has an overall diagnostic sensitivity of 95.8%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 93.9% and an accuracy of 92.4%. CONCLUSION: Although the KSTR members already perform PTNB according to the BTS or ERS/ATS guidelines with excellent results, this survey could be a cornerstone for formulating PTNB guidelines (indications, contraindications, the pre-investigation and post observation after PTNB) in Korea.

A Case of Recurrent Pneumonitis Caused by Bojungikgitang(Bu-Zhong-Yi-Qi-Tang) / 결핵및호흡기질환

Many classes of drug, such as antineoplastic drugs and antiarrhythmic drugs, have potential to induce interstitial lung disease. Herbal medicines are also believed to have the potential to induce pneumonitis. However, to our knowledge, there are no reports of pneumonitis caused by herbal medications in the Korean medical database. We report a case of recurrent pneumonitis caused by a self rechallenge of the Herbal medicine Bojungikgitang (Bu-Zhong-Yi-Qi-Tang : Hochu-ekki-to).

Sonographic Findings of Variable Chest Wall Disorders

Variable chest wall disorders include hemorrhage, inflammation and a tumor on the chest wall. Especially in females, abnormal anterior chest wall findings can appear as breast lesions due to the anatomic relationship between the chest wall and the breast. Sonography is the first diagnostic tool to utilize for chest wall disorders and has an important role for the differential diagnosis. In this study, we introduce sonographic findings of the various chest wall disorders that are discovered incidentally during an examination for a palpable mass or pain in the breast. We also describe sonographic findings that additionally performed of sonography-guided core needle biopsy.

Eosinophil-derived Neurotoxin and Eosinophil Cationic Protein Levels Correlate with Bronchial Wall Thickness in Children with Asthma Exacerbation / 소아알레르기및호흡기학회지

PURPOSE: Eosinophilic inflammation plays a critical role in asthma and high-resolution computed tomography (HRCT) scoring systems have been used to evaluate the extent and severity in long standing adult asthma. We investigated if there is a correlation between eosinophil degranulation markers and HRCT scores in childhood asthma. METHODS: Children with acute asthma exacerbation (n=25) underwent HRCT and were assessed for bronchial wall thickening (BWT), low lung density (LLD), and bronchial dilatation (BD) using semi-quantitative scoring techniques. Serum eosinophil-derived neurotoxin (EDN) and eosinophil cationic protein (ECP) levels indicating eosinophil degranulation were determined. Comparisons were made with normal control subjects (n=14). RESULTS: BWT (P<0.001) and LLD (P<0.001) scores were higher in the childhood asthma group than in the control group, but BD scores were not. The EDN (r=0.405, P<0.05) and ECP (r=0.565, P<0.01) levels significantly correlated with BWT scores, but not with LLD and BD in the childhood asthma group. The EDN (r=0.710, P<0.0001) and the ECP (r=0.580, P<0.0001) levels were significantly correlated with serum total eosinophil counts. CONCLUSION: The EDN and ECP levels were correlated with BWT scores on HRCT. These findings suggest that EDN and ECP may be valuable for quantifying airway thickening in children with asthma exacerbation.

Cardiac Hemangioma of the Left Atrial Appendage Associated with Hepatic Hemangiomas: The CT and Coronary Angiographic Findings

Cardiac hemangioma is a rare benign tumor of the heart. We report here on a case of cardiac hemangioma that originated from the left atrial appendage; this was observed on the CT and coronary angiographic findings and the lesion was pathologically proved.

Propylthiouracil-induced Diffuse Pulmonary Hemorrhage: A Case Report with the Clinical and Radiologic Findings

Propylthiouracil (PTU) is a drug that's used to manage hyperthyroidism and it can, on rare occasions, induce antineutrophil cytoplasmic antibody-associated vasculitis that involves multiple organ systems and it can also cause extremely rare isolated or diffuse pulmonary hemorrhage. We report here on a case of a patient who developed diffuse pulmonary hemorrhage after she had been taking PTU for five years. The patient is a 33-year-old woman who presented with hemoptysis. Simple chest radiographs and the chest CT showed bilateral ground-glass opacity, consolidation and pulmonary arterial hypertension. The bronchoalveolar lavage fluid revealed alveolar hemorrhage. The laboratory values showed increased perinuclear-antineutrophil cytoplasmic antibody (p-ANCA) and anti-peroxidase antibody titers.

A Case of Pulmonary Edema by Idiopathic Rupture of Mitral Chordae Tendinae / 결핵및호흡기질환

The typical radiographic findings of pulmonary edema from the increased hydrostatic pressure shows centrally localized consolidation, which is known as a "butterfly or bat's wing" pattern. These terms describe the anatomic distribution of edema that uniformly involve the hilum and medulla of the lung but not the peripheral region of the lung parenchyma (cortex). We present a case of butterfly wing-like pulmonary edema on a chest radiograph by mitral regurgitation due to an idiopathic chordal rupture.

CT Findings of Swyer-James-MacLeod Syndrome in Adults: Are There Any Different Findings with Aging?

PURPOSE: We wanted to evaluate whether there is any different finding on CT with aging for the patients suffering with adult Swyer-James-MacLeod Syndrome (SJMS). MATERIALS AND METHODS: We included 11 patients (7 males and 4 females) who underwent chest CT scan among 18 patients who were suspected of suffering with SJMS on chest radiographs. The range of age was from 28 to 85 years (mean: 58.5). We evaluated the diameter of both the main pulmonary artery (MPA) with its ratio, and the diameter of the pulmonary trunk (PT) to evaluate the possibility of pulmonary arterial hypertension, and the presence or absence of bronchiectasis. We also evaluated the relationships between these findings and aging. RESULTS: SJMS affected the left lung in 10 of 11 patients. The mean diameter of the main pulmonary artery of the normal lung was 2.5 cm and it was 1.6 cm in the involved site. The mean ratio of the normal MPA diameter to the involved one was 1.6 and this did not correlate with age (p>0.1). The mean diameter of the pulmonary trunk was 2.8 cm and this increased with age (p0.5). CONCLUSION: SJMS absolutely affected the left lung much more than the right lung. All the patients demonstrated about 1.6 times the compensatory hypertrophy of MPA of the normal lung compared with that of the affected lung on chest CT, which was irrespective of age. The presence or absence of bronchiectasis has no correlation with age.

Effects of School-based Nutrition Education for Korean Food Guide on Food Intake Frequency of Adolescents / 대한지역사회영양학회지

The purpose of this study was to examine the effect of nutrition education about the Korean food guide to middle school students on food intake measured by food frequency. Three hundred first graders were sampled from two coeducational middle schools located in the small city of Chungnam area, and divided into 167 (74 boys, 93 girls) education groups of one school and 133 (70 boys, 63 girls) non education groups of the other school. Nutrition education was given to the education group for a total of 16 hours and no education to the non education group during the same period. After education, average nutrition knowledge scores of education group increased from 6.40 +/- 2.17 to 6.81 +/- 1.56 significantly, especially boys with a high range of increase and girls no increase. Dietary habit scores improved significantly from 46.2 +/- 6.5 to 49.1 +/- 6.2 in both boys and girls of education group. Of the knowledge and dietary habits, ability of choosing a balanced meal, biased eating to some food, and taking diverse foods at every meal improved significantly in education group. In non education group no significant increases of either nutrition knowledge scores and dietary habit scores were shown. In addition education group showed significant increases after education, in the intake frequencies of rice noodle loaf bread, kimchi, green and yellow vegetables, and soybean soybean curds by 0.27, 0.23, 0.40 and 0.32 servings per day, compared with non education group. These changes were greater in girls than in boys. According to these results, it can be concluded that nutrition education about the Korean food guide improved effectively not only student's nutrition knowledge and dietary habits, but also healthy food intake ability. It is necessary to prepare long-term and continuous school-based nutrition education programs for the students to get into a habit of healthy food intake.

Hyperostosis of the Maxillary Sinus Wall in Aspergillosis: Is it a Characteristic Finding?

PURPOSE: To determine whether the wall thickening of the maxillary sinus is a characteristic finding in aspergillosis. MATERIALS AND METHODS: In 103 patients, including 26 with aspergillosis, 21 with inverted papilloma (IP), and 56 with unilateral chronic sinusitis, the thickness of the maxillary sinus wall was determined by CT scanning. All cases were proven pathologically, and patients with a history of previous surgery or bone destruction were excluded. Two neuroradiologists retrospectively reviewed the CT scans using bone window settings for sinus wall hyperostosis and the presence of intrasinus calcification. Thickening of the maxillary sinus wall was assessed visually in a semiquantitative manner, and graded as 'none'(absence of thickening), 'mild'(thickening of up to 1.5 times), or moderate to severe(over 1.5 times thicker than normal contralateral sinus wall at its thickest point). RESULTS: Moderate to severe wall thickening was found only in patients with aspergillosis (21/26, 80.8%). Mild wall thickening was seen in two patients with aspergillosis (2/26, 7.7%), in 12 of 21 with IP (57.1%), and in 5 of 56 with chronic maxillary sinusitis (8.9%). Most cases of chronic maxillary sinusits (51/56, 91.1%), 9/21 IP cases (42.9%), and 3/26 cases of aspergillosis (11.5%) showed no thickening of the maxillary sinus wall. Calcifications were found in 18 patients with aspergillosis (69.2%), in no patient with IP (0%), and in one with chronic maxillary sinusitis (1.8%). CONCLUSION: We suggest that 'moderate to severe' wall thickening of the maxillary sinus is the characteristic finding of aspergillosis. Although various sinonasal diseases can cause bone change, CT findings of hyperostosis of the maxillary sinus and intrasinus calcification are very helpful in differentiating fungal sinusitis from other types of chronic inflammatory lesions.

Extrapleural Pneumonectomy for Diffuse Malignant Mesothelioma: Report of four cases / 대한흉부외과학회지

Diffuse malignant mesothelioma is a rare malignant tumor having poor prognosis. There is still no widely acceptable staging system of the disease and pathologic diagnosis is difficult. Although surgical treatment for diffuse malignant mesothelioma has been controversial, extrapleural peumonectomy in selected patients could prolong the survival when it was combined with adjuvant chemotherapy and radiation therapy. We experienced 4 cases of diffuse malignant mesothelioma for 7 years since 1992, they were treated with extrapleural pneumonectomy without early postoperative mortality. Three patients underwent adjuvant therapy after surgery; chemotherapy in two, and chemo-radiation therapy in one, but one patient could not receive adjuvant therapy because of postoperative complication of hypoxic brain damage due to cardiac torsion and empyema. In this article, we describe surgical experience of extrapleural pneumonectomy and discuss about the controversial points of the disease.

Late Lung Parenchymal Changes on HRCT in Children with mycoplasma Pneumonia

PURPOSE: To evaluate late lung parenchymal change, as seen on high-resolution CT(HRCT) in children with mycoplasma pneumonia MATERIALS AND METHODS: Twenty-three patients [15 boys and 8 girls aged two to 13 (mean, 6) years] with mycoplasma pneumonia underwent HRCT four to 39 (mean, 10) months after initial infection. Using increased mycoplasma antibody titer(> 1:640) mycoplasma pneumonia was diagnosed, and patients were divided into two groups : high titer group (antibody titer>1: 5120), and lower titer group (<1:5120). CT scans were performed using 2mm collimation and 5-10mm interval from apex to diaphragm. In seven patients who were cooperative, both inspiratory and expiratory scans were obtained at a window width of 1600 HU and level of -700. HRCT findings of mosaic low attenuations and changes in bronchioles and bronchial walls were assessed by three radiologists and correlated with initial chest radiographic findings. RESULTS: On HRCT, 17 of 23 patients (74 %) demonstrated abnormal findings. These included mosaic attenuation of lung density alone in 11 of 17 patients (65%), mosaic attenuation associated with bronchiectasis in five ( 29 %), and bronchiectasis only in one (6 %). Mosaic attenuation was more accentuated on expiratory scans than on inspiratory. These findings were obtained in 10 of 12 high titer group and in 7 of 11 in the lower titer group. In 15 of 23 patients (65 %), involved ageas seen on HRCT exactly corresponded with initially involved areas seen on chest radiographs (CXR). Two patients in whom findings on initial CXR were normal showed mosaic attenuation on HRCT. Six patients in whom such findings were abnormal showed normal findings on HRCT, a fact which reflected their complete recovery. CONCLUSION: The most common late parenchymal change in mycoplasma pneumonia, as seen on HRCT, was mosaic attenuation of lung density followed by bronchiectasis. The latter is presumably due to bronchiolitis obliterans, a well-known complication. We believe that HRCT is very useful for the evaluation of long-term sequelae of mycoplasma pneumonia in children.

Lung parenchymal change after the resolution of Adenovirus Pneumonia: Chest Radiographs and High-resolution CTfindings

PURPOSE: To evaluate lung parenchymal change as seen on chest radiographs and high-resolution CT (HRCT) afterthe resolution of adenovirus pneumonia (a common cause of lower respiratory infection in infants and children),and the usefulness of HRCT during follow-up. MATERIAL AND METHODS: Four to 13(mean, 8) months after recovery, tenpatients infected with adenovirus pneumonia underwent HRCT and chest radiographs. Eight were boys and two weregirls, and their mean age was 26(range, 14-45) monthes. Adenovirus pneumonia had been confirmed by viral isolationin culture or serologic test. CT scanning was performed during quiet breathing ; collimation was 2mm and theinterval from apex to diaphragm was 5-10mm. Lung settings were 1600 HU (window width) and -700 HU(level). CTfindings were assessed and compared with chest radiographs by two chest radiologists, who reached a consensus. Thepatients were clinically followed up for one year. RESULT: On chest radiographs, hyperlucent lung was seen in 8of 10 patients (80%) ; in one other there was partial collapse, and in one, findings were normal. The most commonHRCT finding was a mosaic pattern of lung attenuation with decreased pulmonary vascularity in the area of lowerattenuation ; this was seen in 8 of 10 patients (80%). Other findingss were partial collapse, bronchiectasis, andbronchial wall thickening, each seen in two patients, and reticulonodular density, seen in one. In two patientsHRCT findings were normal ; in one of these, chest findings were noraml but a mosaic pattern of lung attenuationwas found in all lobes. During follow-up, three patients wheezed continously. CONCLUSION: In cases of adenoviruspneumonia, HRCT demonstrated more specific parenchymal change than did chest radiographs ; a mosaic pattern oflung attenuation was seen, with decreased pulmonary vascularity in areas of lower attenuation ; bronchiectasis,bronchial wall thickening, and reticulo-odular density were also noted. These findings were presumably due tobronchiolitis obliterans, a well known complication of adenovirus pneumonia, and are prognostically helpful.

Mycoplasma Pneumonia in Children: Radiographic Pattern Analysis and Difference in Resolution

PURPOSE: By analysing frequency and disease progression, this study aimed to investigate and predict the prognosis of mycoplasma pneumonia according to radiographic pattern. MATERIALS AND METHODS: We retrospectively reviewed plain chest radiographs of 230 patients in whom mycoplasm pneumonia had been serologically confirmed.Their age ranged from two months to 14 years and two months, and 203(88.3%) were younger than eight years. Radiographic patterns were classified as air space consolidation, bronchopneumonic, interstitial pneumonic ordiffuse mixed infiltrating type. The radiologic resolution period for each type was analysed by the resolution of symptoms and normalization of radiologic findings. RESULTS: The bronchopneumonic type, which was the most common, was seen in 82 patients (35.6%), airspace consolidation in 58 (25.2%), interstitial in 55 (23.9%), and diffuse mixedin 22 (9.57%). In thirteen patients (5.7%), chest radiographs were normal, though the clinical and radiologic resolution period for each type was variable. The mean resolution period of the air space consolidation type was 14.5 days, bronchopneumonic, 7.6 days ; interstitial, 10.5 days, and diffuse mixed, 15.6 days. The airspace consolidation type needed the longest recovery period, exceeded only by the diffuse mixed type. CONCLUSION: The bronchopneumonic type was the most common radiographic pattern of mycoplasma pneumonia. The prognosis of the airspace consolidation type seems to be poorest, since this required the longest recovery period.